Related Experiment Video
Updated: Dec 10, 2025
Laparoscopic Posterior Radical Antegrade Modular Pancreatosplenectomy for Distal Pancreatic Carcinoma
Published on: December 29, 2023
Posterior Retroperitoneoscopic Versus Laparoscopic Transperitoneal Adrenalectomy: A Systematic Review by an Updated
Paschalis Gavriilidis1,2, Christian Camenzuli3, Anna Paspala4
1Department of Endocrine and Thyroid Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 OHS, UK. pgavrielidis@yahoo.com.
Background:
Two main minimal access adrenalectomy techniques are available: laparoscopic transperitoneal (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA). This study aims to compare these approaches in an updated meta-analysis of randomised controlled (RCT) and non-randomised comparative (NRT) trials.
Methods:
A systematic search of comparative LTA and PRA studies was performed. Standard demographic and surgical data were recorded. Outcome measures compared included: operative time, estimated blood loss (EBL), conversion to open, post-operative pain, time to oral intake and ambulation, early morbidity, hospital length of stay (HLOS) and mortality. Quality of RCTs and NRTs was assessed using Cochrane and ROBINS-I, respectively, and heterogeneity using the I2 test. Dichotomous and continuous variables were compared using odds ratios and mean/standard difference. Studies were then combined using the Mantel-Haenszel method. Meta-analysis was performed by fixed- and random-effect models.
Results:
Following exclusions, 12 studies were included in the analysis: 3 RCTs and 9 NRTs. These reported a total of 775 patients: 341 (44%) PRA and 434 (56%) LTA. Demographics were similar except for tumour size which was smaller (by 0.78 cm) in PRA (p = 0.003). Significant differences in outcome were seen in EBL (18 mls less in PRA, p = 0.006), time to oral intake (3.4 h sooner in PRA p = 0.009) and HLOS (shorter in PRA by 0.84 day, p = 0.001).
Conclusions:
This analysis demonstrates that while PRA tends to be performed for smaller tumours it allows for less EBL, earlier post-operative oral intake and shorter hospital stays. In appropriately selected patients, it represents an invaluable tool in the endocrine surgeon's armamentarium.
